Editorial Commentary: The Anterolateral Ligament Is Only Part of the Puzzle of Anterolateral Corner Injury in Anterior Cruciate Ligament Disruption and Reconstruction.

Abstract

Over the past decade, there has been an increased awareness of the role of the anterolateral corner (ALC) in the setting of anterior cruciate ligament (ACL) injury and ACL reconstruction. Although several studies have debated the existence, exact anatomy, and function of the ALC, the role in clinical practice is well recognized. Biomechanical studies have assessed the role of the anterolateral ligament (ALL), superficial and deep Kaplan fiber layers of the iliotibial band, the anterolateral capsule with the ALL, and the capsulo-osseous layer within the ALC. Furthermore, both biomechanical and clinical studies support the role of either ALL reconstruction or lateral extra-articular tenodesis, such as the modified Lemaire or Arnold-Coker modification of the McIntosh technique in the setting of ACL reconstruction. Not only have many randomized controlled trials shown decreased failure or rerupture rates with adding these procedures, but they also show minimal complication rates, equivalent to superior patient-reported outcome measures and decreased presence of persisting rotatory instability or positive pivot shift. These developments have caused a major shift in the treatment of young patients with ACL injuries, especially those who have ligamentous laxity, hyperextension, involvement in pivoting sports, or contralateral injuries. The next steps should focus on which patients require ALC procedures, the role of ALC procedures with hamstring versus quadriceps or bone-patellar tendon-bone autograft, and the development of post-traumatic osteoarthritis.